Strict Serological and Clinical Follow-up in Celiac Disease Can Unmask Underlying Threats: A Case of Concomitant Pancreatic Cancer

Abstract

Monitoring adherence to a gluten-free diet (GFD) in patients with celiac disease (CD) remains a significant clinical challenge. Accurate assessment of dietary compliance is crucial not only for controlling symptoms but also for preventing long-term complications associated with persistent intestinal inflammation. Current guidelines generally recommend follow-up serological testing at 6 and 12 months after diagnosis, followed by annual assessments. However, these intervals may not be sufficient in all cases, particularly for patients presenting with atypical symptoms, overlapping gastrointestinal complaints, or comorbid conditions that can obscure the true disease activity. We report the case of a 46-year-old male patient diagnosed with CD who was subsequently found to have pancreatic cancer. This case highlights the potential limitations of standard follow-up intervals and underscores the importance of shortened and more frequent serological monitoring immediately after diagnosis. Early testing can facilitate timely detection of complications or comorbidities and enable prompt differential diagnosis, ultimately improving patient outcomes. Adult CD patients may present with subtle or overlapping clinical features, making early and proactive surveillance especially critical. This experience emphasizes the need to individualize follow-up strategies, taking into account patient age, clinical presentation, and risk factors for additional gastrointestinal or systemic diseases. Optimizing the timing and frequency of serological assays may enhance clinical decision-making, allow earlier detection of comorbidities, and support more effective management of CD in everyday practice. Furthermore, these observations could encourage exploration of more flexible and risk-adapted monitoring schedules in future evidence-based guidelines, particularly for adult patients potentially at higher risk of serious complications, including malignancies.